Most of the pathogenic bacteria in biliary tract infection are enteric Gram-negative bacteria. In severe acute cholangitis, the pressure of the biliary tract increases, causing capillary rupture and necrosis, and the endotoxin released by Gram-negative bacteria in the bile can directly enter the liver bloodstream through the liver cell barrier, resulting in endotoxemia. In addition, due to the anatomical characteristics of the vascular plexus located under the mucous layer of the small bile duct, endotoxin in the bile may flow back to the portal vein and hepatic sinusoids through the bile canaliculus-venous reflux pathway. Endotoxemia impacts shock and organ failure and is the pathological basis leading to the severe clinical course of severe acute cholangitis. Experiments have shown that those with high endotoxin levels often suffer from shock, disseminated intravascular coagulation, organ failure, and poor prognosis, while those with gradually decreasing endotoxin levels have a good prognosis. Due to the obstruction of stones, endotoxin in bile will continue to enter the blood circulation under the influence of biliary pressure, causing the level of plasma endotoxin to remain high. Therefore, strengthening the monitoring of changes in plasma endotoxin levels after biliary drainage is helpful to objectively evaluate the curative effect of surgery.
The gallbladder is an important member of the digestive system. Its function is to store liver bile and participate in the digestion of foods rich in fat. The presence of gallstones can promote gallbladder infection by blocking the normal flow of bile and causing cholestasis. Endotoxin is an important initiating factor that mediates Gram-negative bacterial sepsis. It induces the synthesis and release of various cytokines in the host through its binding to receptors or regulatory proteins and stimulates a series of pathophysiological changes in the body. Current studies have confirmed that endotoxin may cause gallbladder damage due to its various pathophysiological effects. In a clinical study, the Limulus amebocyte assay detected and semi-quantified endotoxin in bile samples. It was found that compared with endotoxin-negative patients, endotoxin-positive patients had significantly increased jaundice and abdominal pain, indicating that endotoxin is associated with gallbladder disease. Therefore, endotoxin may become a test index to play a role in the clinical diagnosis of gallbladder disease.
Figure 1. Classification of gallstones. (Lammert F, et al., 2016)
By detecting the content of endotoxin in blood and bile of patients with biliary stones and patients with different degrees of biliary tract infection under various pathological conditions, the role of endotoxin in liver injury in patients with biliary tract infection can be further judged. Blood endotoxin monitoring can reflect the degree of local biliary tract infection and can be used as an objective auxiliary index for disease prediction or prognosis, thus clarifying the position of blood endotoxin measurement in gallstone and biliary tract infection. So far, there is no ideal measurement method for monitoring the course of severe acute cholangitis, evaluating the curative effect, and judging the prognosis. The dynamic observation of plasma endotoxin level and its correlation analysis as a quantitative laboratory index for clinical problems in this area and its practical value is worthwhile.
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